Dr. William Gibson and I co-authored this article. He is a psychologist and neuropsychologist at the VA Medical Center in Canandaigua, NY.
It's not a new phenomenon for a politician to use someone's suffering for political gain, but Sarah Palin, in addressing her son's arrest last week for domestic violence, has managed both to propagate a series of misunderstandings about PTSD and to dishonor veterans. In addition, she demonstrated the worst way for families and friends to support someone struggling with PTSD.
If you have a friend or family member you know or believe has PTSD, here are some ways you can help them:
Be aware that PTSD can leave sufferers believing the world is fundamentally unsafe and that they can trust almost no one. They behave out of character. PTSD alters people in significant ways that affect behavior. In addition to distressing symptoms such as nightmares, flashbacks, loss of memory, insomnia, hyper-vigilance, and intrusive memories or images, they often feel emotionally numb and socially isolated, cut off from others and from their own feelings. And they may try to self-medicate with alcohol or drugs or be self-destructive.
As much as you can, do not allow your worry or guilt to co-opt their struggle. You may feel at a loss for how to respond. You may even blame yourself for the sufferer's experiences or reactions. However, the situation is about the other person's experience and his or her struggle to make sense of it, not about you, about whether you're a good partner or parent or friend, or about anything you have done.
You may also feel uncomfortable talking to the person about his or her experiences. Maybe you find yourself saying, well, it wasn't that bad, or other people had it worse. Maybe you interrupt or change the subject. While you may think you are protecting yourself and the person from re-experiencing the horrific situation, you are likely sending a message that the PTSD sufferer cannot feel safe discussing all aspects of him or herself with you--and at worst, you may add to their trauma by underscoring their feelings of separation and alienation.
It helps to remember that the symptoms that constitute PTSD arise from a normal human defense system triggered by traumatizing experiences. These symptoms are not a sign of character weakness or mental defect.
If your friend or family member wants to talk to you, listen with compassion, deeply from your heart, without worrying what you might say in response or even if everything you hear makes sense. Hear the story from his or her perspective, and try to keep your own expectations or point-of-view in check. If you have had similar experiences, now is not the time to bring them up--your experience is not theirs, and right now, you are trying to help the person speaking to you.
Ask if it's okay to ask questions, and consider your questions with care. It is easy to find ways to judge or blame the person by suggesting he or she could or should have behaved differently, but remember: you don't know because you weren't there. Instead, ask how the person feels about what happened and try to listen without judgment or opinions.
They can also experience a response to trauma called moral injury--a condition that may arise when one witnesses, participates in, or fails to prevent events that violate one's basic sense of right and wrong or when one feels betrayed by the violation of what is right by a person with authority in a high-stakes situation.
Moral injury shares some PTSD symptoms such as anger, depression, intrusive memories, and insomnia, but it also includes other symptoms such as survivor guilt, grief, shame, self-condemnation, despair, alienation, outrage at authorities, and loss of meaning, faith, or life purpose.
Some VA clinicians think moral injury may be a more lasting and difficult form of suffering for veterans. Recovery involves not only talking about it, but also having a group or community of support for rebuilding a moral identity and meaning system.
Here are some other things to keep in mind as you support someone you love who struggles with PTSD and moral injury:
Be aware that we can be traumatized by other people's trauma. Because humans are highly social animals, our brains are wired such that we feel other people's feelings, which can sometimes affect us. While this is often called secondary trauma, it is trauma nonetheless. It's important to check yourself and your readiness to listen. Not all sufferers of PTSD want to talk to family members for fear of traumatizing them, and emotional closeness may make them more reluctant to share. They will benefit from talking about their experiences, so encourage them to share, even if it is not with you.
Not everyone who experiences a trauma develops PTSD. In fact about 11-20% of combat veterans who served in Iraq and 7-8% of civilians in America who experience trauma are diagnosed with it. Combat experience is stressful and life-threatening, but people handle it in different ways based on past experiences and training and intangibles such as mental toughness and emotional resiliency. Experiencing trauma at one point in time makes a person more vulnerable to a recurrence. Being abused as a child, being sexually assaulted or mugged, or surviving a catastrophic disaster are common precipitators. In addition, a person can have moral injury but not have PTSD and vice versa.
Although PTSD is associated with an increased risk in violent behavior, most PTSD-sufferers have never engaged in violence. Sometimes the only emotion PTSD sufferers feel--and are able to express--is anger. Especially when people try to self-medicate pain with drugs or alcohol, their anger may lead them to exhibit behaviors that become sensationalized in the media. Remember, though, that everything a person does is not necessarily due to his or her PTSD. Don't fall into the trap of blaming your loved one's behavior on PTSD and absolving them of any responsibility for that behavior or for seeking help for their problems.
One of the hardest--and most heartbreaking--things to remember is that you can do everything right, you can respond compassionately to your loved one, and still that person may continue to experience symptoms or engage in self-destructive behaviors. We can't fix a person with PTSD or moral injury, but we can support them with compassion, which is of vital importance to recovery. Research on PTSD has yielded many helpful treatments, and trained clinicians are needed for recovery, but so are family and friends who care.
So, if you have a friend or family member who suffers from PTSD, the best ways to help are to get them the resources they need to move forward in healing, to give them the time and space to process what is happening to them, and to listen to their story with compassion and without judgment.
Above all, we must realize that the person's traumatic experience almost certainly changed them. They will never be the same as they were before the trauma, but with the care and support of family, friends, and professionals, they can combine the best of who they were with what they've learned from their traumatic experience to emerge from that experience stronger and wiser, just as we will in taking the journey with them.